Interviewer experience, vocal skills and the recruitment of telephone survey respondents

Although telephone interviewing is the main market research method used in Australia, response rates are often low and possibly declining overall. Interviewers are the means by which respondents are recruited and it was hypothesised that their verbal skills and experience would affect response rates. Using data from four market research companies, interviewer experience was shown to be positively related to strike rate (interviews per hour). Apart from having a discernible accent which dampened strike rates and increased refusals, other verbal characteristics had only a weak effect on response rates.

Pharmaceuticals and the consumer movement: the ambivalences of 'patient power'

Consumer and patient advocacy groups (PAGs) are important participants in the politics of pharmaceuticals. Yet very little is known about the precise nature and extent of their influence. It is argued in this article that PAGs fulfil a mixed role within the health system at national and transnational levels, and that they are at times fully incorporated into economic and political power structures. Their frequent dependence on pharma industry funding is of particular concern. PAGs provide a means of direct industry interaction with the final customer, thereby partially bypassing and putting additional pressure on doctors and regulators. The article presents the case for research to establish a better empirical base for discussions about the role of PAGs within contemporary neo-liberal governance structures.

An integrated study of the temporal and spatial variation in the supply of propagules, recruitment and assemblages of intertidal macroalgae on a wave-exposed rocky coast, Victoria, Australia

Recruitment is known to influence distributions and abundances of benthic marine organisms. It is therefore important to document patterns of variability in recruitment and how these relate to patterns in established assemblages. This study provides an integrated assessment of the temporal and spatial variation in supply and recruitment of propagules and established populations of several macroalgae. Propagules in water samples from two stages of the incoming tide, recruitment to artificial substrata and percentage cover of species established on the shore were recorded every 2 months from December 1994 to October 1995, in two zones of an intertidal, wave-exposed rocky shore. Variability in recruitment was measured at three spatial scales: 10s cm, 100s cm and 100s m. Availability and recruitment of most taxa were greatest between April and August, although many species had available propagules and recruited throughout the year. Temporal variation in the established assemblages was, however, more species-specific. Differences in established assemblages between zones were reflected in differences in availability and recruitment of propagules between zones. Recruitment could not be predicted directly from supply of propagules, but the two processes were linked. For most species, the greatest variation in recruitment occurred at the smallest spatial scale of 10s cm, although there was also considerable large-scale (between site) variation in recruitment of several species. Results indicate that while pre-and post-settlement mortality are likely to influence macroalgal distribution and abundance, the temporal and spatial variability in supply and recruitment of propagules can explain much of the patchiness in macroalgal assemblages.

Meiofaunal recruitment to mimic pneumatophores in a cool-temperate mangrove forest: spatial context and biofilm effects

A field experiment was devised to test whether meiofauna that colonised mimic pneumatophores (artificial substrates) resembled the assemblage on adjacent live pneumatophores in three randomly chosen intertidal, estuarine sites. The experiment showed that the close proximity of particular biota on living pneumatophores did not reliably influence subsequent development of assemblages upon mimic pneumatophores within a scale of 10 m during a colonisation period of less than 20 weeks. There was some convergence of the composition of the colonising assemblage of meiofauna on mimic pneumatophores with the local assemblages in sites dominated by barnacles, or where the natural pneumatophores were free from macroscopic epibionts. However, tychopelagic meiofauna from algal epiphytes did not significantly colonise mimic pneumatophores during the 20-week trial, probably due a lack of growing algae. During the conditioning phase suspended in water at a marine site 20 km from the mangroves, mimic pneumatophores acquired an assemblage of meiofauna different from the estuarine assemblage that colonised mimics following implantation in the estuarine mudflat. Enhanced colonisation rates of mimics in suspended bags at the conditioning site may be explained by the absence of benthic macroinvertebrates, and the lack of intertidal exposure. Biofilms aged 2, 7, and 11 weeks had no consistent, different effect on the subsequent colonisation of meiofauna. We conclude that divergence of phytal-based assemblages of meiofauna depends upon the amount of coverage, as well as the type, of fouling macro-epibionts on the pneumatophores. Meiofaunal assemblages on artificial substrates after 20 weeks colonisation displayed less intrinsic patchiness than mature phytal assemblages on natural pneumatophores, and so present a potentially useful way of improving the power of biomonitoring applications using meiofauna.

A conceptual model for recruitment and retention : allied health workforce enhancement in Western Victoria, Australia

Attracting and retaining allied health professionals in rural areas is a recognised problem in both Australia and overseas. Predicted increases in health needs will require strategic actions to enhance the rural workforce and its ability to deliver the required services. A range of factors in different domains has been associated with recruitment and retention in the allied health workforce. For example, factors can be related to the nature of the work, the personal needs, or the way an organisation is led. Some factors cannot be changed (eg geographical location of extended family) whereas others can be influenced (eg education, support, management styles). Recruitment and retention of allied health professionals is a challenging problem that deserves attention in all domains and preparedness to actively change established work practices, both individually as well as collectively, in order to cater for current and predicted health needs. Changes to enhance workforce outcomes can be implemented and evaluated using a cyclic model. The Allied Health Workforce Enhancement Project of the Greater Green Triangle University Department of Rural Health (GGT UDRH) is working towards increasing the number of allied health professionals in the south west of Victoria. Based on themes identified in the literature, an interactive model is being developed that addresses recruitment and retention factors in three domains: (1) personal or individual; (2) organisation; and (3) community.

The relationship between patient blood pathology values and patient falls in an acute-care setting : a retrospective analysis

Few studies have investigated the relationship between patient falls and patient blood pathology values, which can reveal objective information about the health and nutritional status of a patient. It could be that some abnormal values are associated with patients that fall. The objectives of the current study were to determine whether blood pathology values were different in patients who fell compared to patients who did not fall, and whether there was a difference in the type and number of currently documented risk factors for falls found for patients who fell compared to patients who did not fall. A retrospective audit of patient incident reports and medical records was conducted in an acute-care hospital for 220 patients who fell and who did not fall. Faller and non-faller patients were matched by casemix type and length of stay. Findings revealed a significant relationship between patients who fell and the variables of age, confusion status and alkaline phosphatase blood values.

Recruitment of the infaunal bivalve Soletellina Alba (Lamark,1818) (Bivalvia: Psammobiidae) in response to different sediment types and water depths within the intermittently open Hopkins River estuary

Studies examining recruitment processes for soft-sediment macroinvertebrate fauna in intermittent estuaries are rare and most studies of active habitat selection have been tested in the laboratory rather than the field. The present field study examined whether recruitment of the infaunal bivalve Soletellina alba was influenced by water depth and sediment particle size in the intermittent Hopkins River estuary, southern Australia. The number of recruits in sediment trays differed between water depths, but active habitat selection was not evident across treatments of varying sediment particle size. The use of sediments with varying particle sizes also provided an opportunity to identify potential discontinuities in body-size distributions of recruits associated with varying habitat architecture. The length (mm) of recruits was converted to the same scale used to express sediment particle size (i.e. phi units: phi = − log2 of sediment particle size). The size of recruits differed across water depths, but did not differ across treatments with fine (phi = 3) versus coarse (phi = 1) sediment, and no relationships were apparent between bivalve size and sediments consisting of varying particle size. These patterns of recruitment do not correspond with the distribution of adult S. alba within the Hopkins River estuary. Previous sampling has shown that abundances of juvenile and adult S. alba are variable across time, site and water depth, but are often greater at the deeper water depth (1.05 m below the Australian Height Datum). However, recruitment during the present study was greatest at the shallower water depth (0.05 m below AHD), and the apparent absence of active habitat selection suggests that the distribution of adults is unlikely to be attributable to differences in recruitment associated with sediments of varying particle size.

The influence of patient complexity and nurses` experience on haemodynamic decision-making following cardiac surgery

Critical care nurses’ haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses’ haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses’ levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses’ decision-making was influenced by interplay between the complexity of patients’ haemodynamic presentations, nurses’ levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses’ utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses’ professional development and education.

Patient or consumer? The colonization of the psychiatric clinic

Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.

Emergency nurse practitioner care and emergency department patient flow: case-control study

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods: A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

The recruitment and selection of vice-chancellors for Australian universities: an overview

This paper is based on recent Ph.D research. Recruitment and selection practices for appointing Vice Chancellors (VC's) of Australian Universities were examined. The methodology employed involved the use of a survey instrument administered to present and former VC's, Chancellors and members of selection panels, supplemented by interviews. Public domain material was also extensively used. Some key results of the research are reported, including the importance of informal processes such as networking in the selection ofVC's, the key role played by Chancellors, and the continued practice of appointing VC's from within academia rather than the private sector. This is in spite of evidence that the role of the VC has changed to one of strategic planner and business manager rather than the more traditional role, in the context of a rapidly changing external environment.

The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

Patient engagement and coaching for health: the PEACH study- a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

Background
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.
Methods/design
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.
Discussion
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Effects of a walking program in the psychiatric in-patient treatment setting: a cohort study.

Issue addressed: To assess the effectiveness of a walking program in a psychiatric in-patient unit. Method: In-patients at a private psychiatric unit were offered the opportunity to participate in a daily morning 40 minute walk led by an activity supervisor. After discharge, outcomes for patients who had regularly participated in the walking group (n=35) and patients who had not participated (n=49) were compared for length of stay during their period of admission and Clinical Global Impression - Severity (CGI-S) and  Depression Anxiety Stress Scales (DASS) scores measured at admission and discharge. This was a retrospective analysis of data collected routinely. Results: There were no significant differences between the two cohorts on most primary outcome measures, including length of stay, DASS scores at admission and at discharge and CGI-S scores at admission. Patients who had not participated in the walking group had a significantly lower score on a single measure, the CGI-S, than patients who had participated (p=0.001). Conclusions: This study showed no evidence that in-patients benefited from participating in the physical activity program. However, this must be  interpreted within the confines of a number of study limitations and, as such, the findings can neither support nor refute the effectiveness of physical activities.

Risk items associated with patient falls in oncology and medical settings

The aim of this study was to determine whether items on a falls risk-assessment tool, made up of brief cognitive and physical measures that nurses use in practice, differentiated fallers and nonfallers in oncology and medical settings. A measure of leg muscle strength clearly distinguished between fallers and nonfallers, with the latter having stronger leg muscles. For nursing practice, the assessment of patients' muscle strength seems to be the most useful scale for identifying potential fallers.